Browsing by Author "Seedat, Soraya"

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    Assessing post-traumatic stress disorder in South African adolescents: using the child and adolescent trauma survey (CATS) as a screening tool
    (BioMed Central Ltd, 2005) Suliman, S; Kaminer, D; Seedat, Soraya; Stein, Dan J
    BACKGROUND:Several studies have demonstrated that South African children and adolescents are exposed to high levels of violent trauma with a significant proportion developing PTSD, however, limited resources make it difficult to accurately identify traumatized children. METHODS: A clinical interview (K-SADS-PL, selected modules) and self-report scale (CATS) were compared to determine if these different methods of assessment elicit similar information with regards to trauma exposure and post-traumatic stress disorder (PTSD) in adolescents. Youth (n = 58) from 2 schools in Cape Town, South Africa participated. RESULTS: 91% of youth reported having been exposed to a traumatic event on self-report (CATS) and 38% reported symptoms severe enough to be classified as PTSD. On interview (K-SADS-PL), 86% reported exposure to a traumatic event and 19% were found to have PTSD. While there were significant differences in the rates of trauma exposure and PTSD on the K-SADS and CATS, a cut-off value of 15 on the CATS maximized both the number of true positives and true negatives with PTSD. The CATS also differentiated well between adolescents meeting DSM-IV PTSD symptom criteria from adolescents not meeting criteria. CONCLUSIONS: Our results indicate that trauma exposure and PTSD are prevalent in South African youth and if appropriate cut-offs are used, self-report scales may be useful screening tools for PTSD.
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    The association between hypertension and depression and anxiety disorders: results from a nationally-representative sample of South African adults
    (Public Library of Science, 2009) Grimsrud, Anna; Stein, Dan J; Seedat, Soraya; Williams, David; Myer, Landon
    Objective: Growing evidence suggests high levels of comorbidity between hypertension and mental illness but there are few data from low- and middle-income countries. We examined the association between hypertension and depression and anxiety in South Africa. METHODS: Data come from a nationally-representative survey of adults (n = 4351). The Composite International Diagnostic Interview was used to measure DSM-IV mental disorders during the previous 12-months. The relationships between self-reported hypertension and anxiety disorders, depressive disorders and comorbid anxiety-depression were assessed after adjustment for participant characteristics including experience of trauma and other chronic physical conditions. RESULTS: Overall 16.7% reported a previous medical diagnosis of hypertension, and 8.1% and 4.9% were found to have a 12-month anxiety or depressive disorder, respectively. In adjusted analyses, hypertension diagnosis was associated with 12-month anxiety disorders [Odds ratio (OR) = 1.55, 95% Confidence interval (CI) = 1.10-2.18] but not 12-month depressive disorders or 12-month comorbid anxiety-depression. Hypertension in the absence of other chronic physical conditions was not associated with any of the 12-month mental health outcomes (p-values all <0.05), while being diagnosed with both hypertension and another chronic physical condition were associated with 12-month anxiety disorders (OR = 2.25, 95% CI = 1.46-3.45), but not 12-month depressive disorders or comorbid anxiety-depression. CONCLUSIONS: These are the first population-based estimates to demonstrate an association between hypertension and mental disorders in sub-Saharan Africa. Further investigation is needed into role of traumatic life events in the aetiology of hypertension as well as the temporality of the association between hypertension and mental disorders.
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    DSM-IV-defined common mental disorders:association with HIV testing, HIV-related fears, perceived risk and preventive behaviours among South African adults
    (2009) Myer, Landon; Stein, Dan J; Grimsrud, Anna T; Herman, Allen; Seedat, Soraya; Moomal, Hashim; Williams, David R
    Background. There are few reports from South Africa on how common mental disorders may be associated with HIVrelated perceptions and behaviours. Methods. Between 2002 and 2004, 4 351 South African adults were interviewed. Psychiatric diagnoses of depression, anxiety and substance abuse disorders were based on the Diagnostic and Statistical Manual, 4th edition (DSM-IV). HIVrelated fears, perceived risk and behaviour change were measured using multi-item scales. We analysed forms of behaviour change that were appropriate for risk reduction (such as changes in sexual behaviour) separately from behaviour changes that were inappropriate to prevent HIV (such as care over things touched or avoiding certain social situations). Results. The presence of any DSM-IV-defined disorder during the previous 12 months was associated with previous HIV testing, increased HIV-related fears, and high levels of perceived risk of HIV. There were no associations between depression, anxiety and substance abuse disorders and appropriate forms of behaviour change for HIV risk reduction. However, individuals with an anxiety or a depressive disorder were more likely to report inappropriate forms of behaviour change. For example, individuals with any depressive and / or anxiety disorders were 1.57 and 1.47 times more likely, respectively, to report avoiding certain social situations to prevent HIV / AIDS compared with those who did not have such disorders (p < 0.01 for both associations). Discussion. The lack of appropriate forms of behaviour change to prevent HIV transmission, despite increased levels of HIV-related fear and perceived risk, underscores the need for HIV risk reduction interventions for individuals living with common mental disorders in South Africa.
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    Escitalopram in the prevention of posttraumatic stress disorder: a pilot randomized controlled trial
    (BioMed Central, 2015-02-19) Suliman, Sharain; Seedat, Soraya; Pingo, Janine; Sutherland, Taryn; Zohar, Joseph; Stein, Dan J
    Background: A small literature suggests that pharmacotherapy may be useful in the prophylaxis of posttraumatic stress disorder in patients presenting with major trauma. There is relatively little data, however, on the use of selective serotonin reuptake inhibitors (SSRIs) in this context. Methods: 24 week, double-blind placebo controlled study. 31 participants presenting immediately after trauma, and meeting diagnostic criteria for full or partial acute stress disorder were randomized to treatment with 10–20 mg of escitalopram or placebo daily for 24 weeks. 2 participants were excluded from the analysis due to early drop out, leaving 29 participants (escitalopram = 12, placebo = 17) for inclusion in an intent- to- treat analysis. Participants were followed up until 56 weeks, and assessed with the Clinician Administered PTSD Scale (CAPS). A mixed model repeated measures analysis of variance (RMANOVA) was undertaken to determine the efficacy of the intervention on the CAPS score. Results: There was a significant reduction in CAPS score over the course of treatment (F(7, 142) = 41. 58, p < 0.001) in both the escitalopram and placebo groups, with a greater reduction in CAPS score in the placebo group F(7, 142) = 2.12, p = 0.045. There were improvements on all secondary measures, including the Clinical Global Impressions scale, and scales assessing depression, anxiety and disability. Only functional disability outcomes (F(7, 141) = 2.13, p = .04), were significantly different between treatment and placebo groups. In the sample as a whole, improvement in scores were maintained at the 52 week follow-up. Side effects were comparable between the groups. Conclusions: These data are consistent with other recent work indicating that the SSRIs may not be efficacious in the prevention of PTSD. Nevertheless, the small sample size and baseline differences between groups limit the explanatory power of the study. Although a consideration of the possibility of medication prophylaxis in PTSD remains important, both from conceptual and clinical perspectives, caution is needed with regards to the use of SSRIs until their efficacy can be proven. Trial registration: Clinical Trials NCT00300313
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    Impact of childhood trauma on functionality and quality of life in HIV-infected women
    (BioMed Central Ltd, 2011) Troeman, Zyrhea; Spies, Georgina; Cherner, Mariana; Archibald, Sarah; Fennema-Notestine, Christine; Theilmann, Rebecca; Spottiswoode, Bruce; Stein, Dan; Seedat, Soraya
    BACKGROUND:While there are many published studies on HIV and functional limitations, there are few in the context of early abuse and its impact on functionality and Quality of Life (QoL) in HIV. METHODS: The present study focused on HIV in the context of childhood trauma and its impact on functionality and Quality of Life (QoL) by evaluating 85 HIV-positive (48 with childhood trauma and 37 without) and 52 HIV-negative (21 with childhood trauma and 31 without) South African women infected with Clade C HIV. QoL was assessed using the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), the Patient's Assessment of Own Functioning Inventory (PAOFI), the Activities of Daily Living (ADL) scale and the Sheehan Disability Scale (SDS). Furthermore, participants were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D) and the Childhood Trauma Questionnaire (CTQ). RESULTS: Subjects had a mean age of 30.1 years. After controlling for age, level of education and CES-D scores, analysis of covariance (ANCOVA) demonstrated significant individual effects of HIV status and childhood trauma on self-reported QoL. No significant interactional effects were evident. Functional limitation was, however, negatively correlated with CD4 lymphocyte count. CONCLUSIONS: In assessing QoL in HIV-infected women, we were able to demonstrate the impact of childhood trauma on functional limitations in HIV.
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    Impact of common mental disorders during childhood and adolescence on secondary school completion
    (2009) Myer, Landon; Stein, Dan J; Jackson, Pamela B; Herman, Allen A; Seedat, Soraya; Williams, David R
    There are few data from South Africa and other low- and middle-income countries on how mental disorders in childhood and adolescence may influence different aspects of socio-economic position, including educational attainment. We examined the association between early-onset disorders and subsequent educational achievement in a nationally representative sample of 4 351 South African adults. After adjusting for participant demographic characteristics and traumatic life events, post-traumatic stress disorder, major depressive disorder and substance-related disorders were each associated with increased odds of failing to complete secondary education (odds ratios and 95% confidence intervals 2.3, 1.0 - 5.1; 1.7, 1.2 - 2.5, and 1.7, 1.2 - 2.5, respectively). These data point to the role that early-life mental disorders may play in educational achievement and subsequent socio-economic position over the life course.
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    The impact of voluntary exercise on relative telomere length in a rat model of developmental stress
    (BioMed Central Ltd, 2012) Botha, Martmari; Grace, Laurian; Bugarith, Kishor; Russell, Vivienne; Kidd, Martin; Seedat, Soraya; Hemmings, Sian
    BACKGROUND: Exposure to early adverse events can result in the development of later psychopathology, and is often associated with cognitive impairment. This may be due to accelerated cell aging, which can be catalogued by attritioned telomeres. Exercise enhances neurogenesis and has been proposed to buffer the effect of psychological stress on telomere length. This study aimed to investigate the impact of early developmental stress and voluntary exercise on telomere length in the ventral hippocampus (VH) and prefrontal cortex (PFC) of the rat. Forty-five male Sprague-Dawley rats were categorised into four groups: maternally separated runners (MSR), maternally separated non-runners (MSnR), non-maternally separated runners (nMSR) and non-maternally separated non-runners (nMSnR). Behavioural analyses were conducted to assess anxiety-like behaviour and memory performance in the rats, after which relative telomere length was measured using qPCR. RESULTS: Maternally separated (MS) rats exhibited no significant differences in either anxiety levels or memory performance on the elevated-plus maze and the open field compared to non-maternally separated rats at 49 days of age. Exercised rats displayed increased levels of anxiety on the day that they were removed from the cages with attached running wheels, as well as improved spatial learning and temporal recognition memory compared to non-exercised rats. Exploratory post-hoc analyses revealed that maternally separated non-exercised rats exhibited significantly longer telomere length in the VH compared to those who were not maternally separated; however, exercise appeared to cancel this effect since there was no difference in VH telomere length between maternally separated and non-maternally separated runners. CONCLUSIONS: The increased telomere length in the VH of maternally separated non-exercised rats may be indicative of reduced cellular proliferation, which could, in turn, indicate hippocampal dysfunction. This effect on telomere length was not observed in exercised rats, indicating that voluntary exercise may buffer against the progressive changes in telomere length caused by alterations in maternal care early in life. In future, larger sample sizes will be needed to validate results obtained in the present study and obtain a more accurate representation of the effect that psychological stress and voluntary exercise have on telomere length.
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    Life stress and mental disorders in the South African stress and health study
    (2009) Seedat, Soraya; Stein, Dan J; Jackson, Pamela B; Heeringa, Steven G; Williams, David R; Myer, Landon
    Background. Although stressful life events (SLEs) are associated with psychopathology, the contribution from distal and proximal events and the specificity of their association with common mental disorders require further exploration. We examined the association of recent life events and past adversities to mood, anxiety, substance use and impulse control disorders in South Africa. Methods. Data were analysed from the South African Stress and Health study, a population-based study of mental disorders in a nationally representative sample of 4 351 adults. Psychiatric disorders were assessed with the Composite International Diagnostic Interview (CIDI). This included questions covering early and later SLEs (negative life events, relationship stress, partner violence, social strain and adverse events during childhood) and various sociodemographic variables. Logistic regression models were constructed for 3 957 respondents (2 371 female, 1 586 male) with no missing covariate data, to assess life stress and sociodemographic predictors of 12-month and lifetime disorder. Results. Recent negative life events and relationship problems were significant predictors of any 12-month disorder and any lifetime disorder. Physical partner violence predicted any lifetime disorder. There was evidence of specificity for the prediction of mood versus anxiety disorders, with childhood adversity specifically associated with mood disorders but not anxiety disorders. Single marital status was the strongest socio-demographic predictor of any 12-month and any lifetime disorder. Conclusions. Stressful life events, distal and proximal, contribute significantly and independently to the prediction of major psychiatric disorders among South Africans, underscoring the importance of screening adversities in adults with common mental disorders, and of providing appropriate adjunctive interventions.
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    Mental health service use among South Africans for mood, anxiety and substance use disorders
    (2009) Seedat, Soraya; Williams, David R; Herman, Allen A; Moomal, Hashim; Williams, Stacey L; Jackson, Pamela B; Myer, Landon; Stein, Dan J
    Background. Europe and North America have low rates of mental health service use despite high rates of mental disorder. Little is known about mental health service use among South Africans. Design. A nationally representative survey of 4 351 adults. Twelve-month DSM-IV (Diagnostic and Statistical Manual, 4th edition) diagnoses, severity, and service utilisation were determined using the World Health Organization Composite International Diagnostic Interview (CIDI). Twelve-month treatment was categorised by sector and province. South Africans in households and hostel quarters were interviewed between 2002 and 2004 in all nine provinces. Outcome measures. 4 317 respondents 18 years and older were analysed. Bivariate logistic regression models predicted (i) 12-month treatment use of service sectors by gender, and (ii) 12-month treatment use by race by gender. Results. Of respondents with a mental disorder, 25.2% had sought treatment within the previous 12 months; 5.7% had used any formal mental health service. Mental health service use was highest for adults with mood and anxiety disorders, and among those with a mental disorder it varied by province, from 11.4% (Western Cape) to 2.2% (Mpumalanga). More women received treatment, and this was largely attributable to higher rates of treatment in women with mood disorders. Age, income, education and marital status were not significantly associated with mental health service use. Race was associated with the treatment sector accessed in those with a mental disorder. Conclusions. There is a substantial burden of untreated mental disorders in the South African population, across all provinces and even in those with substantial impairment. Greater allocation of resources to mental health services and more community awareness initiatives are needed to address the unmet need.
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    Patterns of substance use in South Africa: results from the South African Stress and Health study
    (2009) Van Heerden, Margaretha S; Grimsrud, Anna T; Seedat, Soraya; Myer, Landon; Williams, David R; Stein, Dan J
    Background. There are limited data on substance use in South Africa. We describe patterns of substance use based on recent, nationally representative data. Methods. Data were derived from the 2002 - 2004 South African Stress and Health (SASH) study. A nationally representative household probability sample of 4 351 adults was interviewed using the paper and pencil version of the World Health Organization Composite International Diagnostic Interview (CIDI). Data are reported for lifetime use, socio-demographic correlates of use, and age of cohort predicting lifetime use for four classes of drugs. Results. The estimate for cumulative occurrence of alcohol use was 38.7%, of tobacco smoking 30.0%, of cannabis use 8.4%, of other drug use 2.0%, and of extra-medical psychoactive drug use 19.3%. There were statistically significant associations between male gender and alcohol, tobacco, cannabis and other drug use. Coloureds and whites were more likely than blacks to have used alcohol, tobacco and other drugs. Clear cohort variations existed in the age of initiation of drug use; these were most marked for other drugs and for extra-medical drug use. Use of all drug types was much more common in recent cohorts, with a similar cumulative incidence of tobacco, alcohol and cannabis use across age cohorts. Conclusions. Epidemiological patterns of use for alcohol, tobacco, cannabis, other drugs and extra-medical drugs provide the first nationally representative data. New findings on race and exploratory data on time trends provide a foundation for future epidemiological work on drug use patterns across birth cohorts and population subgroups in South Africa.
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    Perceived discrimination and mental health disorders: the South African Stress and Health study
    (2009) Moomal, Hashim; Jackson, Pamela B; Stein, Dan J; Herman, Allen; Myer, Landon; Seedat, Soraya; Madela-Mntla, Edith; Williams, D R
    Objectives. To describe the demographic correlates of perceived discrimination and explore the association between perceived discrimination and psychiatric disorders. Design. A national household survey was conducted between 2002 and 2004 using the World Health Organization Composite International Diagnostic Interview (CIDI) to generate diagnoses of psychiatric disorders. Additional instruments provided data on perceived discrimination and related variables. Setting. A nationally representative sample of adults in South Africa. Subjects. 4 351 individuals aged 18 years and older. Outcomes. 12-month and lifetime mood, anxiety and substance use disorders. Results. In the multivariate analyses, acute and chronic racial discrimination were associated with an elevated risk of any 12-month DSM-IV disorder when adjusted for socio-demographic factors, but this association was no longer statistically significant when adjusted for other sources of social stress. In fully adjusted models, acute racial discrimination was associated with an elevated risk of lifetime substance use disorders. Acute and chronic nonracial discrimination were associated with an elevated risk of 12-month and lifetime rates of any disorder, even after adjustment for other stressors and potentially confounding psychological factors. The association of chronic non-racial discrimination and 12-month and lifetime disorder was evident across mood, anxiety, and substance use disorders in the fully adjusted models. Conclusion. The risk of psychiatric disorders is elevated among persons who report experiences of discrimination. These associations are more robust for chronic than for acute discrimination and for non-racial than for racial discrimination. Perceived discrimination constitutes an important stressor that should be taken into account in the aetiology of psychiatric disorders.
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    Pharmacotherapy for post-traumatic stress disorder - a systematic review and meta-analysis
    (2006) Ipser, Jonathan; Seedat, Soraya; Stein, Dan J
    Background. Post-traumatic stress disorder (PTSD) is a prevalent and disabling condition. Evidence that PTSD is characterised by specific psychobiological dysfunctions has contributed to a growing interest in use of medication in its treatment. Objectives. To assess the effects of medication in the treatment of PTSD. Design. Systematic review of randomised controlled trials (RCTs) following the Cochrane Collaboration guidelines. A more detailed version of the review is published in the Cochrane Database of Systematic Reviews. Methods. We searched the Cochrane Depression, Anxiety and Neurosis Group specialised register, the Cochrane Central Register of Controlled Trials (Cochrane Library issue 4, 2004), MEDLINE (January 1966 - December 2004), PsycINFO (1966 - 2004), the National PTSD Center Pilots database, and the meta register module of the Controlled Trials database. Reference lists of retrieved articles were searched for additional studies. Two raters independently assessed RCTs for inclusion in the review, collated trial data, and assessed trial quality. Investigators were contacted to obtain missing data. Summary statistics were stratified by medication class, and by medication agent for the selective serotonin re-uptake inhibitors (SSRIs). Dichotomous and continuous measures were calculated using a random effects model, heterogeneity was assessed, and subgroup/sensitivity analyses were done. Main results. Thirty-five short-term (14 weeks or less) RCTs were included in the analysis (4 597 participants). Symptom severity for 17 trials was significantly reduced in the medication groups, relative to placebo (weighted mean difference (WMD) = −5.76, 95% confidence interval (CI): −8.16 - −3.36, N = 2 507). Similarly, summary statistics for responder status from 13 trials demonstrated overall superiority of a variety of medication agents compared with placebo (relative risk (RR) = 1.49, 95% CI: 1.28, 1.73, number needed to treat (NNT) = 4.85, N = 1 272). Medication and placebo response occurred in 59.1% (N = 644) and 38.5% (N = 628) of patients, respectively. Of the medication classes, evidence of treatment efficacy was most convincing for the SSRIs. Medication was also effective in reducing the severity of the PTSD re-experiencing/intrusion, avoidance/numbing, and hyperarousal symptom clusters in 9 trials (N = 1 304). In addition, medication was superior to placebo in reducing comorbid depression and disability. Medication was also less well tolerated than placebo. A narrative review of the 3 maintenance trials suggested that long-term medication may be required in treating PTSD.Conclusion. Medication treatments can be effective in treating PTSD, acting to reduce its core symptoms, as well as associated depression and disability, and should be considered as part of the treatment of this disorder. The findings of this review support the status of SSRIs as first-line agents in the pharmacotherapy of PTSD, as well as their value in longterm treatment. However, there remain important gaps in the evidence base, and there is a continued need for more effective agents in the management of PTSD.
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    Pharmacotherapy for post-traumatic stress disorder- a systematic review and meta-analysis
    (2006) Ipser, Jonathan; Seedat, Soraya; Stein, Dan J
    Background. Post-traumatic stress disorder (PTSD) is a prevalent and disabling condition. Evidence that PTSD is characterised by specific psychobiological dysfunctions has contributed to a growing interest in use of medication in its treatment. Objectives. To assess the effects of medication in the treatment of PTSD. Objectives. To assess the effects of medication in the treatment of PTSD. Design. Systematic review of randomised controlled trials (RCTs) following the Cochrane Collaboration guidelines. A more detailed version of the review is published in the Cochrane Database of Systematic Reviews. Methods. We searched the Cochrane Depression, Anxiety and Neurosis Group specialised register, the Cochrane Central Register of Controlled Trials (Cochrane Library issue 4, 2004), MEDLINE (January 1966 - December 2004), PsycINFO (1966 - 2004), the National PTSD Center Pilots database, and the meta register module of the Controlled Trials database. Reference lists of retrieved articles were searched for additional studies. Two raters independently assessed RCTs for inclusion in the review, collated trial data, and assessed trial quality. Investigators were contacted to obtain missing data. Summary statistics were stratified by medication class, and by medication agent for the selective serotonin re-uptake inhibitors (SSRIs). Dichotomous and continuous measures were calculated using a random effects model, heterogeneity was assessed, and subgroup/sensitivity analyses were done. Main results. Thirty-five short-term (14 weeks or less) RCTs were included in the analysis (4 597 participants). Symptom severity for 17 trials was significantly reduced in the medication groups, relative to placebo (weighted mean difference (WMD) = −5.76, 95% confidence interval (CI): −8.16 - −3.36, N = 2 507). Similarly, summary statistics for responder status from 13 trials demonstrated overall superiority of a variety of medication agents compared with placebo (relative risk (RR) = 1.49, 95% CI: 1.28, 1.73, number needed to treat (NNT) = 4.85, N = 1 272). Medication and placebo response occurred in 59.1% (N = 644) and 38.5% (N = 628) of patients, respectively. Of the medication classes, evidence of treatment efficacy was most convincing for the SSRIs. Medication was also effective in reducing the severity of the PTSD re-experiencing/intrusion, avoidance/numbing, and hyperarousal symptom clusters in 9 trials (N = 1 304). In addition, medication was superior to placebo in reducing comorbid depression and disability. Medication was also less well tolerated than placebo. A narrative review of the 3 maintenance trials suggested that long-term medication may be required in treating PTSD. Conclusion. Medication treatments can be effective in treating PTSD, acting to reduce its core symptoms, as well as associated depression and disability, and should be considered as part of the treatment of this disorder. The findings of this review support the status of SSRIs as first-line agents in the pharmacotherapy of PTSD, as well as their value in longterm treatment. However, there remain important gaps in the evidence base, and there is a continued need for more effective agents in the management of PTSD.
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    Socio-behaviour challenges to phase III HIV vaccine trials in sub-Saharan Africa
    (2005) Smit, Joalida; Middelkoop, Keren; Myer, Landon; Lindegger, Graham; Swartz, Leslie; Seedat, Soraya; Tucker, Tim; Wood, Robin; Bekker, Linda-Gail; Stein, Dan J
    Background: A number of countries in sub-Saharan Africa are preparing for HIV vaccine efficacy trials. Social and behavioural factors related to HIV transmission require examination in each setting where these trials are considered. As part of this, several countries have also recently begun preparatory research investigating relevant social and behavioural issues. There is a need for a review of the literature to help focus such research efforts in Sub-Saharan Africa. Objective: To examine key social and behavioural issues that may impact on the conduct of HIV vaccine efficacy trials in sub-Saharan Africa. Design: Literature review Methods: Major databases (PubMed, PsychInfo, EBSCOhost, and AIDSline) were searched for literature that discussed social and behavioural issues related to HIV vaccine trials. Three areas are highlighted as being particularly significant for HIV vaccine research: (1) willingness to participate in future HIV vaccine efficacy trials, (2) retention of participants in studies, and (3) sexual risk reporting during trials. For each of these topics, major findings from both developed and developing countries are described and avenues for further research are discussed. Results: There are few data from Sub-Saharan Africa regarding willingness to participate in HIV vaccine trials. Data on participant retention rates varies widely, and maintaining large cohorts of individuals within Phase III trials presents an important challenge. In addition, the possible impact of trial participation on sexual disinhibition, and response bias on sexual risk-reporting remain as issues for HIV vaccine trials in African contexts. Conclusions: Social and behavioural research forms an important part of preparations for HIV vaccine efficacy trials, and there is a clear need for more research of this type in Sub-Saharan Africa. Innovative approaches are required to address issues such as willingness to participate in vaccine research, participant retention during efficacy trials, and the accurate reporting by participants of sexual risk behaviours.
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    The prevalence and correlates of hallucinations in a general population sample: findings from the South African Stress and Health Study
    (2011) Temmingh, H S; Stein, Dan J; Seedat, Soraya; Williams, D R
    Objective: Large epidemiological surveys conducted in the developed world have found rates of psychotic symptoms in the general population to be as high as 10-28%. However, there are few data available from developing countries, including African countries, on the prevalence and correlates of psychotic symptoms. This study investigates the prevalence and correlates of psychotic symptoms (ie hallucinations) in a general population sample of South African adults. Method: As part of the South African Stress and Health Study the prevalence of auditory and visual hallucinations was determined in a large community based sample of 4250 participants utilizing the Composite International Diagnostic Interview (CIDI). In addition, socio-demographic and clinical correlates as well as indicators of service utilization and functional impairment were determined. Results: The prevalence of any reported hallucination was 12.7%, a rate comparable to that found in studies from the developed world. Multivariate analyses revealed a significant association between role impairment, service utilisation, suicidality and reported auditory or visual hallucinations. No significant association was found between urbanicity and reported psychotic symptoms. Conclusion: Our finding that psychotic symptoms (ie hallucinations) are significantly associated with functional impairment and service utilization supports the potential clinical significance of such symptoms, even in the African context.
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    The South African Stress and Health (SASH) study: 12-month and lifetime prevalence of common mental disorders
    (2009) Herman, Allen A; Stein, Dan J; Seedat, Soraya; Heeringa, Steven G; Moomal, Hashim; Williams, David R
    Background. The South African Stress and Health (SASH) study is the first large-scale population-based study of common mental disorders in the country. This paper provides data on the 12-month and lifetime prevalence of these conditions. Methods. Data from a nationally representative sample of 4 351 adults were analysed. Mental disorders were assessed with the Composite International Diagnostic Interview (CIDI). An extensive survey questionnaire detailed contextual and socio-demographic factors, onset and course of mental disorders, and risk factors. Simple weighted cross-tabulation methods were used to estimate prevalence, and logistic regression analysis was used to study correlates of 12-month and lifetime prevalence. Results. The lifetime prevalence for any disorder was 30.3%, and the most prevalent 12-month and lifetime disorders were the anxiety disorders. The Western Cape had the highest 12-month and lifetime prevalence rates, and the lowest rates were in the Northern Cape. Conclusions. The SASH study shows relatively high 12-month and lifetime prevalence rates. These findings have significant implications for planning mental health services.
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    Understanding the impact of hazardous and harmful use of alcohol and/or other drugs on ARV adherence and disease progression
    (Public Library of Science, 2015) Kader, Rehana; Govender, Rajen; Seedat, Soraya; Koch, John Randy; Parry, Charles
    The objective of this study was to understand the impact of hazardous and harmful use of alcohol and/or other drugs on ARV adherence and disease progression among HIV patients. A cross-sectional study design was used. A total of 1503 patients attending HIV clinics in Cape Town, South Africa were screened for problematic substance use. A sub-sample of 607 patients (303 patients who screened positive for problematic substance use and 304 who did not) participated in this study. Hazardous or harmful alcohol use and problematic drug use predicted missing and stopping ARVs which, in turn, was associated with a decrease in CD4 counts and more rapid HIV-disease progression and poorer health outcomes in people living with HIV/AIDS (PLWHA). The findings of this study underscore the need for an integrated approach to managing substance-use disorders in PLWHA.